Tennis injuries: types

About one-third of tennis injuries are traumatic (sprains[1], muscle pulls, and fractures), mostly to lower extremities, and are usually not related to a player's technique.

The remaining two-thirds of tennis injuries are overuse (strains[2], tendinitis, lower back pain), occur to different parts of the body (equally distributed among upper and lower extremities), are definitely related to player's technique and many could be avoided with proper technique.

Proper warm-up reduces risk of traumatic tennis injury

Many injuries to a tennis player's hip, lower back, shoulder and sometimes elbow result from a lack of flexibility (inflexibility in hip or shoulder rotation, inability to bend over and touch toes, tightness in elbow extension or forearm rotations).

A proper warm-up loosens muscles and tendons to increase range of motion of joints, and, of course, to literally, warm up the body by increasing body heat and blood flow. This is because warm muscles and enlarged (e.g. dilated) blood vessels use oxygen from the blood and burn fuel stored in the muscles more efficiently. A proper warm-up two components: aerobic exercise and dynamic stretching.

Light aerobic exercise

A proper warm-up begins with 5 to 10 minutes of warm-up jogging at a very easy pace (40% of maximum heart rate), increasing to 60%, followed by a 5-minute recovery period. This portion of the warm-up should neither be performed too early (warming up and then sitting next the court for 30 minutes may leave the player stiffer than they were before) or intensely (if the aerobic exercise is too vigorous, the player will end up tired).

Dynamic stretching

The second part of a warm-up regimen, to be performed immediately after the aerobic warm-up and as soon as possible before a practice or match, involves dynamic stretching (stretching muscles while moving).

Throw out the old: Research has shown that the kind of stretching routine most of us have been doing since we were in grade school (holding a stretch for 20 or 30 seconds, supposedly to prepare muscles for exercise, or static stretching) not only fails to do what it is supposed to do but may actually weaken muscles and be harmful.

Studies have found that static stretching weakened muscle strength by as much as 30 percent and that stretching the leg muscles in one leg reduced strength in the other leg for up to 30 minutes after stretching. While a player may think that static stretching increases flexibility, what is actually happening is that the stretching has simply increased the athlete's mental tolerance for the discomfort of the stretch, while the muscle itself is actually weaker! Studies have made it increasingly clear that static stretching alone before exercising doesn't reduce the traumatic injury risk.

Bring in the new: Studies show that the new way of stretching (dynamic stretching) increases power, flexibility and range of motion, and may reduce injuries. In one study of female collegiate soccer players[3], non-contact ACL injuries[4] were reduced by nearly half among players who followed a warm-up program[5] that included both dynamic stretching exercises and static stretching. In another, researchers at Bloomsburg University of Pennsylvania found that golfers were nine times less likely to be injured if they warmed up.

Tennis-specific dynamic stretching exercises

Because tennis involves rapid movement in different directions, tennis players need to perform stretching exercises that involve many different parts of the body. The United States Tennis Association's player development program recommends the following dynamic stretches:

Straight-leg march (hamstrings and gluteus muscles)

kick one leg straight out in front, with the toes flexed and pointed straight up;

reach the opposite arm to the upturned toes;

drop the leg and repeat with the opposite leg and arm

repeat sequence at least 6 or 7 times

Scorpion (lower back, hip flexors and gluteus muscles)

Lie on stomach with arms outstretched and feet flexed so only toes are touching ground

Kick right foot toward left arm, then kick left foot toward right arm

Begin slowly and repeat up to 12 times

Handwalks (shoulders, core muscles, hamstrings)

Stand straight with legs together

Bend over until both hands are flat on ground

"Walk" with hands forward until back is almost extended

Keeping legs straight, inch feet towards hands

Walk with hands forward again

Repeat 5 or 6 times.

Static stretching (standing in one spot, such as bending over to touch your toes or hamstring stretch) should be performed immediately after and between, not before, matches.

Overuse injuries in tennis

There are multiple causes of overuse injuries in tennis, the three primary reasons being inadequate rest and recovery, incorrect and inadequate tennis-specific conditioning, and incorrect grips and strokes.

A new study in the American Journal of Sports Medicine found an association between injuries to the palm or ulnar side of a player's wrist and the Western or semi-Western grips used to hit the hard, top-spin forehand used by most players.

The most common tennis overuse injury is tennis elbow (tendinitis in the elbow), which almost always caused by an improper grip, repeated failure to make contact with the ball in front of the player's body, or improper stroke technique.

A tennis ball striking a racket transfers shock or jar to the hand, wrist and arm, with the muscles in the wrist and arms acting as shock absorbers. The shock is minimized when player hits ball closer to middle of strings. Frequent mis-hits can contribute to hand, elbow and shoulder injuries. A ball hit off-center causes the racket to twist (impulsive torque). To control the increased torque, muscles, tendons and ligaments have to work harder, which can lead to overuse injuries.

Reducing overuse injuries

Here are some ways to reduce these types of overuse injuries:

Heavier racket with bigger head. A player may like the feel of lighter racquet holding it in pro shop, but the lighter racquet can lead to injury by increasing the amount of torque on top spin ground strokes, which today's new, lighter rackets encourage.

Reduced string tension which will decrease the force and shock by increasing the amount of time the ball stays on the string (e.g. "dwell time")

Stiffer racket. The stiffness of the racket frame may alter the amount of shock; a stiffer racket, while providing more power, also transfers more shock to the arm.